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Stroke Medical Treatment

A stroke occurs when blood supply to the brain is interrupted or there is bleeding in the brain. Within minutes, brain cells begin to die. It is urgent to get emergency care at the first sign of a stroke. Early treatment saves many lives and reduces the effects of stroke.

After emergency treatment for a stroke, medical treatment aims to prevent the stroke from getting worse. It also aims to prevent other problems that can develop from the stroke. These types of problems are called complications. The doctor continues to monitor the stroke patient. The doctor may also prescribe more tests for the patient. The tests help to find what caused the stroke and how to prevent another one. These tests are called diagnostic (die-ag-NOS-tik) tests.

Medicines

The most common type of stroke is ischemic (iss-KEY-mik) stroke. This type of stroke occurs when a clot blocks a blood vessel and stops blood flow to the brain.

Drug therapy may be given to patients with ischemic stroke or those at risk of having ischemic stroke. The medicines that are used most often fall into 2 groups: anticoagulants (an-tee-ko-AG-you-lents) and antiplatelets (an-tee-PLATE-lets).

Anticoagulants

Drugs in this group help to keep blood clots from forming. Sometimes these drugs are called anti-clotting agents or blood thinners. They work by making your blood take longer to clot. There is some risk for bleeding when you take anticoagulants, so your doctor will monitor you closely.

Heparin

When a CT scan of a stroke patient’s brain shows no signs of bleeding, heparin may be prescribed. Heparin may not dissolve a blood clot that already exists, but it helps to keep the blood clot from getting bigger. This drug also helps to prevent new clots from forming. Heparin is given by intravenous (IV) line or by injection.

When you take heparin, you may have some risk for bleeding. You need frequent blood tests to check how clotting is affected. A dose of heparin is active for only 4 to 6 hours, so it is easy to control.

Tell your doctor right away if you have any signs of bleeding:

  • Large bruises
  • Blood in your urine or stool
  • Black or dark stools
  • Bleeding gums

Low-Molecular-Weight Heparin

This type of heparin may give you less risk for bleeding. It is given 1 or 2 times a day. This form of heparin is given by injection under the surface of the skin (subcutaneous). Some common brand names for this type of heparin are Lovenox and Fragmin.

Tell your doctor right away if you have any signs of bleeding:

  • Large bruises
  • Blood in your urine or stool
  • Black or dark stools
  • Bleeding gums

Coumadin

Coumadin can help patients who have high risk for having a stroke. This includes patients who have had a mini-stroke (TIA) or have abnormal heart valves. It also includes patients with an abnormal heart rhythm called “AF” (atrial fibrillation). Coumadin is the brand name for this drug; warfarin is the generic name. Coumadin comes as a pill that is taken by mouth.

This drug works by reducing the effect of vitamin K, a vitamin that helps your blood to clot. Because many foods contain vitamin K, it is very important to keep the same amount of vitamin K in your diet every day when you are taking Coumadin.

Foods that are high in vitamin K include:

  • Beverages: herbal teas containing tonka beans, melilot (sweet clover), or woodruff; green teas
  • Fats: mayonnaise
  • Oils: soybean oil, canola oil
  • Vegetables: broccoli, brussels sprouts, cabbage, cauliflower, collard greens, green scallions, kale, lettuce, mustard greens, parsley, spinach, turnip greens

You must take Coumadin exactly as your doctor prescribes. You will need frequent blood tests to check if the dosage needs to be changed. Tell your doctor right away if you notice any signs of bleeding:

  • Black or dark stools
  • Bloody urine
  • Bleeding gums

Whenever you go to any kind of dentist or doctor, be sure they know that you take Coumadin. You should also wear a medical alert tag that says you are taking the blood thinner Coumadin.

Antiplatelets

Platelets are blood cells that are sticky and help the blood to clot. Antiplatelets are drugs that keep platelets in the blood from sticking together. This helps to prevent blood clots that could cause stroke. These drugs can help patients who have had a mini-stroke (TIA) or a past stroke. These drugs may also be given to patients who are at risk for a stroke. Take these drugs with food because they may irritate your stomach. Antiplatelets give you less risk for bleeding than anticoagulants do.

Aspirin

Aspirin helps to keep platelets from “clumping” in patients who have some risk for ministrokes
(TIAs) or stroke. Aspirin is also an anti-inflammatory drug. Inflammation in the arteries seems to play a role in stroke. So this is another reason why aspirin helps prevent stroke. You must take aspirin for about 8 days before it starts to slow “clumping.”

 Many over-the-counter (OTC) drugs contain some aspirin, so it’s important to avoid them when you are taking aspirin. Check with your doctor before you take any OTC drug. Before you have surgery or other procedures that are invasive, you may need to stop taking aspirin. Tell your doctor if you have any of the following:

  • Ringing in your ears
  • Dizziness
  • Confusion
  • Pain in your belly

Plavix

Plavix is a pill taken by mouth once a day. This drug may cause headache or dizziness when you first start taking it. Tell your doctor if you have any of the following:

  • Skin rashes
  • Chest pain
  • Fainting
  • Severe headache
  • Large bruises

Aggrenox

This new medicine combines 2 drugs: aspirin and Persantine. Both drugs help to keep blood clots from forming. Together, the drugs are effective in reducing mini-strokes (TIAs) and strokes. This medicine is a capsule taken by mouth 2 times a day. Tell your doctor if you have any of the following:

  • Signs of bleeding, such as black or dark stools, bloody urine, or bleeding gums
  • Skin rash
  • Stomach upset
  • Dizziness

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